| NPI | 1972584605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: 50.001489RX) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 50001489) |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2021-06-22 |